What are the pros of EBC (evidence based care)
looks for the very best scientific and clinical evidence for treating and managing a problem
improves quality, safely and patient outcomes
increases nurse satisfaction
reduces costs
where does the best evidence come from?
TEST Q
- well designed
- systematically conducted research studies
- in scientific/ peer reviewed journals
the need for evidence based practice “bedside” implications
what all adds to “evidence-based clinical decision making” ?
- evidence from research, evidence based theories, clinical experts, and opinion leaders
- evidence from assessment of patients history and physical and available health care resources
- information about patient preferences and values
- clinical expertise
sources of evidence?
- textbooks
- articles from nursing and health care literature
- peer reviewed journals
application of evidence
differ based on patients values, state of health, preferences, concerns or expectations
involves ethical and accountable professional nursing practice
use critical thinking skills
what the steps of evidence based practice?
Cultivate - a spirit of inquiry
Ask- a clinical question in PICOT format
Search - for the best evidence
Appraise- critically appraise the evidence
Integrate - the evidence
evaluate- the outcomes of practice decision or changes
communicate/share- the outcomes of the evidence based practice decision.
Cultivate a spirit of inquiry
what are the parts ?
- must have never ending spirit of inquiry
constantly questioning current practices
cultivate/ work at an institution where nurses are encouraged to question practices
Ask a clinical question in the PICOT format ?
developing a PICOT question
P-patient population of interest I- intervention of interest C- comparison of interest O- Outcome T-time
Example: will patients with diabetes (P) who take Lantus (I) at bedtime have better A1 C levels (O) after 6 months (T) than those who take Lantus in the morning (C)
search for the best evidence
ASK experts for help
- nursing faculty
- Librarians
- advanced practice nurses
- staff educators/ developers
- risk managers
A medical librarian can
- identify the databases that are available to you
- identify key words that will provide the best answer to your PICOT question.
Critically appraise the evidence
after critiquing all articles for a PICOT question
- synthesize or combine the findings
- consider the scientific rigor/quality of evidence and whether it has application in practice
requires systematic approach to determine
- value
- feasibility
- usefulness of evidence
Integrate the evidence
-pilot study can show if change can be implemented easily. ALWAYS consider a pilot study…learning on a small scale can forestall challenges
-apply the research in your plan of care for a patient
use evidence as rationale
just like on your CRT!!
-incorporate into policies and procedures
-education about the change must occur
-large-scale change requires planning.
Evaluate the outcomes of the Practice Decision or change
after applying evidence, evaluate the outcome
- was the change effective?
- are modifications needed?
- should the change be discontinued
unexpected events or results may occur
communicate the outcomes of the evidence-based practice decision
after implementing, communicate the results
- clinical staff on the unit
- nursing practice council or the research council
- clinicians outside of unit/facility
- professional conferences and meetings
Nursing research
A way to identify new knowledge, improve professional education and practice, and use resources effectively
many professional and specialty nursing organizations support the conduct of research for advancing nursing science.
Outcomes Research
- helps patients/providers make informed decisions on the basis of current evidence
- typically focuses on the benefits, risk, costs and holistic effects of a treatment on patients
- outcomes must be observable or measurable
Scientific method
- is THE foundation of research
- the most reliable and objective means of acquiring and conducting research and gaining knowledge
- a step- by- step process to ensure that findings from a study are valid, reliable, and generalizable to a similar group of subjects.
which of the following is the first step of the research process
IDENTIFY the problem
Nursing and the scientific approach
-research allows you to study nursing questions and problems in greater depth within the context of nursing.
Quantitative
- experimental research
- nonexperimental research
- surveys
- evaluation research
Qualitative
- ethnography
- phenomenology
- grounded theory
Research Process
- identify area of inquiry
- literature review
- form research team
- design study
- obtain approval from participants (informed consent)
- collect data, considering data limitations
- address implications for nursing practice
Performance improvement (PI)
- it is a formal approach for the analysis of health care-related processes
Outcomes measures
-begins at staff level in identifying quality problems
sentinel events: a patients safety event that results in death, permanent harm or severe temporary harm
active errors: made by people on the from line such as clinicians and nurses
latent errors: less apparent failures of organization or design that contribute to the occurrence of active errors
PI +EBP= excellent patient care and outcomes.
